Despite consistent findings that stressful life events increase the risk of illness, the role of psychosocial stress in the etiology of periodontal disease remains poorly understood. Past reports have earlier been anecdotal in nature or inadequate conceptualizations of psychosocial stress or poor clinical measures of periodontal disease. At this time however, well characterized human models of chronic stress, along with sufficiently sensitive indicators of periodontitis, make feasible studies in this area. The project is designed as a preliminary investigation to assess whether a relationship exists between psychosocial stress and periodontitis. Using a cross-sectional design, we will compare clinical and laboratory findings from a group of Alzheimer caregivers to diagnose of a matched comparison group. Long term caregivers of family members with Alzheimer Disease have been shown to undergo chronic stress, and are usually in an age group which is susceptible to chronic adult periodontitis. In addition, this group has been shown to have immune deficits and to be at increased risk for illness. Consequently, Alzheimer caregivers may be an excellent model of human stress in which to study periodontitis. The first project aim is to determine if chronically stressed Alzheimer caregivers have greater periodontitis than a matched comparison group. Comparison of probing depth, clinical attachment level, bleeding index, and gingival crevicular fluid concentrations of PGE2 and b-glucuronidase between groups will be made. The second project aim is to determine which, if any, of selected variables are potential mediators between stress and periodontitis. Complete blood counts, salivary immunoglobulins, social support, dental plaque, and neutrophil function (chemotaxis, superoxide production, phagocytosis and killing) will be related to the clinical findings. In addition to assessing the utility of a chronic stress model to explore the relationship of psychosocial stress to periodontal disease, this study will provide epidemiologic information about the oral health of individuals who provide long-term care to family members with Alzheimer Disease.